Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000561 DEA: 010J8904 EFIS: 0119000119
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-36-3.9/6.0
Work Description: HOT MIX ASPHALT, AGGREGATE BASE, AND STRUCTURAL CONCRETE.
Location Description: HUMBOLDT COUNTY AT CARLOTTA FROM 0.2 MILE WEST OF FISHER ROAD TO 0.2 MILE WEST OF WILDER ROAD
Contractor Name: MERCER-FRASER COMPANY
Contractor Address: 200 Dinsmore Dr., Fortuna, CA 95540
Resident Engineer: Cody Long Structure Rep.: Shantanu Nalawade
DIME Sample ID: 2025-06-13-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM6 - Steel Check Sample Plate
Sample Taken Date: 06/13/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/16/2025
The quantity of what the sample constitutes: 39,320 lbs (4,152 lbs. of this rebar)
A brief description of the sample: (2) #4 A615/A706 Grade 80 Rebar
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Camblin Steel
DIME Test ID: 2025-06-13-2-1
Test Method: ASTM A370-20: Standard Test Methods and Definitions for Mechanical Testing of Steel Products (Tensile - Round Sample)
Verified Date: 06/30/2025
Date Tested: 06/30/2025
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test: Ratio Tensile/Yield - 1.40, 1.40
Uniform Elong - 11.66, 12.91
Test Result Compliance:
Additional Comments When Verified:
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Number of Samples
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2
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| Sample | Heat Number | Diameter (in) | Area (sqin) | Stress at Offset (psi) | Tensile Strength (psi) | Elongation in 4 x d (%) | Tested By | | 1 | 4147709 | 0000 | 0.20 | 84500 | 118600 | 12.69 | Atlas | | 2 | 4147709 | 0000 | 0.20 | 84500 | 118200 | 13.70 | Atlas |
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UTM
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NA
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Temperature
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0 f
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